The Big Society: nudging the public towards better health

The final event in our series on health and the Big Society covered some interesting ground, including the role of reciprocity in health and social care, volunteering, and how to shape the environments in which patients make their choices.

However, the clear focus, and the subject to which the discussion continued to return, was the effectiveness of nudges in changing health behaviours.

Dr David Halpern, Director of the Behavioural Insight Team at the Cabinet Office, stressed that despite the fact that health behaviours are responsible for more than half of avoidable healthy years lost, it is estimated that less than 0.5 per cent of health research funds are spent on behavioural research – this balance is not right. Philosophically the government has a clear preference for nudge over compulsion and voluntary agreements over regulation.

Business, and particularly the food and alcohol industries, clearly has a critical role to play. Baroness Buscombe, Chair of the Press Complaints Commission and a member of the Public Health Commission, shared her experience of working with industry in developing Change4Life and the ongoing work around the Responsibility Deal, while Dr Andrew Jones, Group Medical Director at Nuffield Health, discussed how Nuffield Health was using behavioural psychology to help nudge the behaviour of its patients and customers. There are commercial examples of positive public health initiatives: Mars has reduced the size of its famous bars – although the real test of corporate resolve will be where there are conflicts – rather than such star-crossed alignments between profit and public health motives

It therefore remains to be seen whether the Responsibility Deal will deliver more broadly, or whether tighter regulation by the government – which has already shown itself ready to regulate around below-cost alcohol sales – will eventually be required both in terms of incentives and of effectiveness. As one of the audience pointed out, the strict regulation of smoking in public places delivered results far more quickly and comprehensively than a myriad of micro-nudges would have done.

More broadly, changing social norms will be critical to the success of health behaviour change. Clearly, the long-term change in social norms in relation to smoking made the public response to tighter regulation more positive and effective. A critical question is whether wider application of nudging will widen or narrow inequalities in health? In many cases, the more educated and wealthy may have the greatest capability to respond; the government needs to evaluate the impact of nudge policies on  the behaviour of different groups.

Changing social norms means changing what is happening among peer groups and local communities. But when, for instance, smoking rates are so specific to social groups and micro geographies (as in parts of Warrington for example, where rates are close to 40 per cent for some communities but as low as 3 per cent elsewhere), will any amount of nudging act powerfully or swiftly enough to overcome such deeply embedded and normalised behaviour? In such communities, empowering local people to find solutions by using the new powers of localism – including local regulation – may be a more effective answer.

Nudging individuals to change their behaviour clearly has an important role in improving health, but ultimately changes to communities and society are needed if we are to tackle deeply ingrained inequalities.

Watch all the presentations and listen to questions from the floor at this Big Society event on Nudging improvements in public health

Keep up to date

Subscribe to our email newsletters and follow @TheKingsFund on Twitter to see our latest news and content.


#316 Peter Roberts
Time Bank Broker

Is it just me? We condemn ‘grooming’. The Prevent strategy funds projects that teach people how propaganda works so they won’t fall for it. Teachers explain how advertising works so kids can see through it. Why is this particular form of covert manipulation perfectly OK?

#321 NHS health worker
If you contact me l'll tell you
if you contact me l'll tell you

I have found these discussions most interesting, I work in a rurally deprived area with high levels of everything you don't want. Frankly 'nudging' would only work with a tiny amount of my caseload the rest need the 'covert manipulation' of the previous commentator. For those of working these vulnerable caseloads you need more than change theories and trying to sustain motivation. In my personal opinion alot of recommendations are made by people who do not work these areas e.g. commissioners, researchers and parliament. Ask me!

#324 Peter Roberts
Time Bank Broker

Nobody 'needs' covert manipulation. The State has 11-13 years to mould and manipulate youngsters but once they hit 18 they are adults. Persuading an adult is legitimate. Manipulation isn't.

'Nudging' also cannot work without real choice. Decent jobs on proper pay, less stress, a better education, positive discrimination and help to develop skills - like cooking - are all things that might allow people to make a choice.

As most of us are well aware, the advertising agencies are the real criminals.

#327 Peter Roberts
Time Bank Broker

Whoops ...and the manufacturers of cigarettes and high sugar / fat / salt foods.

Mars reducing the size of bars and 'regulating' below-cost alcohol sales is good. Persuading pizza delivery companies not to give out free 2 litre bottles of coke would save a few lives too.

There is an even better alternative. If a poisoner gives someone small doses of arsenic until they die they are charged with murder. What is the actual difference here?

#546 Meris Michaels

Apply the example of smoking or marketing junk food to children to cell phone use. How can we nudge the public into understanding the harmful effects of the waves produced by these devices on their children? In the US and certain European countries, local initiatives are beginning to grow to ban use of cell phones by children under a certain age. A Canadian example shows that some private schools (the wealthier and better educated) are demanding removal of Wi-Fi, which also emits harmful EM waves, from schools in favor of wired access to the Internet. In public schools, this is not the case. Teachers, parents, students are less unaware of the effects of Wi-Fi on children's health. Any thoughts about wireless technology regulation?

Add new comment